| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1120 |
Prophylaxis - child |
3,967 |
3,927 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
3,305 |
3,279 |
$89K |
| D1206 |
Topical application of fluoride varnish |
4,060 |
4,023 |
$79K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,484 |
1,451 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
694 |
680 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,249 |
1,238 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
146 |
67 |
$9K |
| D1999 |
|
577 |
546 |
$7K |
| D0330 |
Panoramic radiographic image |
156 |
156 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
800 |
762 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
122 |
28 |
$6K |
| D1351 |
Sealant - per tooth |
232 |
49 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
214 |
184 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
598 |
467 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
34 |
30 |
$672.86 |
| D1354 |
|
30 |
12 |
$75.00 |